What is the treatment for kleptomania?

Treatment of Kleptomania

Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) combined with a selective serotonin reuptake inhibitor (SSRI) is the first-line treatment for kleptomania. This approach addresses both the compulsive nature of the disorder and the underlying serotonergic dysfunction.

First-Line Treatment Options

• SSRIs (fluoxetine, paroxetine) have demonstrated effectiveness in treating kleptomania by addressing the serotonergic dysfunction that appears to underlie the disorder 1
• CBT with exposure and response prevention techniques should be implemented alongside medication, similar to treatment approaches for obsessive-compulsive spectrum disorders 2
• Psychoeducation for both patients and family members is essential to address stigma, improve understanding of the condition, and enhance treatment adherence 2

Pharmacological Treatment Algorithm

First-Line:

• Begin with an SSRI (fluoxetine or paroxetine) at standard doses for 8-12 weeks to determine efficacy 1
• If partial response, continue treatment for at least 12-24 months after achieving symptom reduction to prevent relapse 2

Second-Line (for inadequate response):

• Consider switching to a different SSRI or increasing to higher doses 2
• Augmentation strategies may include:
  • N-acetylcysteine (has shown efficacy in impulse control disorders) 2
  • Mood stabilizers if comorbid mood disorders are present 3

Third-Line:

• For treatment-resistant cases, consider glutamatergic agents (memantine, topiramate) as augmentation 2
• In severe cases with significant functional impairment, specialized treatment providers should be consulted 2

Psychotherapeutic Approaches

• CBT with ERP should focus on:
  • Identifying triggers for stealing urges 2
  • Developing coping strategies to manage impulses 2
  • Practicing exposure to triggering situations while preventing the stealing behavior 2
• Motivational interviewing techniques can help build therapeutic alliance and address poor insight or treatment resistance 2
• Group therapy may provide additional support and reduce stigma 2

Treatment Considerations for Special Populations

• For patients with comorbid mood disorders (especially bipolar disorder):
  • Mood stabilizers should be the foundation of treatment before adding SSRIs 3
  • SSRIs should be used cautiously and only in combination with mood stabilizers to prevent triggering manic episodes 3
• For patients with legal complications:
  • Treatment should address both the kleptomania symptoms and the consequences of legal problems 4
  • Focus on improving impulse control, as legal problems in kleptomania may be associated with generalized deficits in inhibitory control 4

Monitoring and Maintenance

• Use standardized measures like the Yale-Brown Obsessive Compulsive Scale as a surrogate marker to gauge response to treatment 5
• Regular monitoring for symptom recurrence, especially during periods of stress or when comorbid conditions worsen 6
• Maintenance treatment should continue for at least 12-24 months after achieving remission to prevent relapse 2

Common Pitfalls and Caveats

• Kleptomania is often underdiagnosed and undertreated, with many patients seeking help only after legal consequences 6
• Patients may not disclose stealing behaviors due to shame and stigma, requiring sensitive screening approaches 6
• Comorbid conditions (especially depression) are common and may require simultaneous treatment 7
• Discontinuation of medication can lead to rapid resurgence of kleptomanic behavior 1
• Treatment should not be limited to addressing the stealing behavior but should also focus on improving overall functioning and quality of life 4